Adding Fluoride to Water Backed by UK CMOs

Peter Russell

September 24, 2021

Fluoride is set to be added to drinking water across the UK after all four chief medical officers backed its use to reduce tooth decay.

In a joint statement, Prof Chris Whitty and colleagues said it was clear that tooth decay could significantly affect individuals’ general health and wellbeing and could have a detrimental effect on children's learning and development as pain and infections from decay can result in school absences.

In 2019, 23.4% of 5-year-olds in England and 26.5% of P1 children in Scotland had experienced tooth decay, they said, while the figure was 34.2% in Wales in 2015 to 2016.

NHS Costs

A report by Public Health England in 2018 concluded that water fluoridation could substantially reduce hospital admissions for tooth extraction. In 2019 to 2020, 35,190 children aged up to 19 in England were admitted to hospital for tooth extraction at an estimated cost to the NHS of £54.6 million.

Fluoride occurs naturally in some water and some foods as well as in most toothpastes. The mineral is also added to water in some areas.

The chief medical officers said that if all 5-year-olds with drinking water with less than 0.2 mg/l fluoride instead received at least 0.7mg/l from a fluoridation scheme, then the number experiencing dental caries would be lower.

The estimated decline would be 17% in the least deprived areas, rising to 28% in the most deprived, they said, while the number of hospital admissions for tooth extractions in children and young people could reduce by between 45% and 68%.

They also dismissed concerns that adding fluoride to water could cause significant fluorosis at the levels used in public health, and said that that concerns of increases in hip fracture, Down's syndrome, kidney stones, bladder cancer, or osteosarcoma were not backed up consistent clinical evidence.

"Water fluoridation is an area that often attracts exaggerated and unevidenced statements that can cause unnecessary concern," they wrote.

The joint statement concluded that while there was a "balance of risk and benefit", fluoridation should be supported to reduce an "entrenched inequality" in tooth decay across the UK.

"On balance, there is strong scientific evidence that water fluoridation is an effective public health intervention for reducing the prevalence of tooth decay and improving dental health equality across the UK," they wrote." It should be seen as a complementary strategy, not a substitute for other effective methods of increasing fluoride use."

'Highly Effective'

The strategy attracted widespread support from experts in the field.

Dr John Morris, senior lecturer in dental public health at the University of Birmingham, told the Science Media Centre that water fluoridation was a "highly effective public heath intervention for combating tooth decay" and a "very cost-effective intervention".

David Conway, professor of dental public health at the University of Glasgow, acknowledged that compulsory fluoridation would be resisted by some campaigners.

"There is an anti-water fluoride lobby, which is not dissimilar to the anti-vax/anti-mask groups – their voices can be loud and drown out the public health evidence and advice, so a clear public health campaign is essential," he advised.


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